Provider Demographics
NPI:1669766200
Name:SAN ROMAN, VICTOR HUGO (PA)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:HUGO
Last Name:SAN ROMAN
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:1760 CHICAGO AVE
Mailing Address - Street 2:#J3
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2300
Mailing Address - Country:US
Mailing Address - Phone:951-781-2200
Mailing Address - Fax:
Practice Address - Street 1:333 E ARROW HWY UNIT 220
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91785-7008
Practice Address - Country:US
Practice Address - Phone:909-476-2023
Practice Address - Fax:909-697-2900
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2024-08-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant